Maust Donovan T, Sirey Jo Anne, Kales Helen C
Dr. Maust and Dr. Kales are with the Department of Psychiatry, University of Michigan, and the U.S. Department of Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Healthcare System, both in Ann Arbor (e-mail:
Psychiatr Serv. 2017 May 1;68(5):449-455. doi: 10.1176/appi.ps.201600197. Epub 2017 Jan 3.
The study compared distress levels among two groups of older adults who had been newly prescribed an antidepressant by their primary care physician, those with major depressive disorder (MDD) and those without MDD.
This analysis used a convenience sample of participants (N=231) who had been newly prescribed an antidepressant in a randomized controlled trial of a program to improve antidepressant adherence and depression outcomes among older adults (≥55). After determining the proportion of participants with and without MDD (using the Structured Clinical Interview for DSM-IV), the authors compared groups on demographic, clinical, and psychosocial characteristics, including the 12-Item Short-Form Health Survey physical and mental component summary scores (PCS and MCS). Logistic regression was used to test the association of these characteristics with antidepressant use in the absence of MDD.
Most (57%) participants did not have MDD. This group was older (69.4 versus 64.7, p<.001), had a larger proportion of white participants (82% versus 56%, p<.001), and reported better physical (PCS, 43.4 versus 39.9, p=.03) and emotional (MCS, 40.2 versus 30.5, p<.001) well-being compared with the group with MDD. In the final regression model, white race (adjusted odds ratio [AOR]=3.11, p=.03) and better emotional well-being (AOR=1.16, p<.001) were associated with antidepressant use in the absence of MDD.
Older adults prescribed antidepressants in the absence of MDD did not report similar distress levels compared with their counterparts with MDD. Given the continued emphasis on screening for depression in primary care, it is important to consider the potential for overtreatment.
本研究比较了两组由初级保健医生新开具抗抑郁药的老年人的痛苦程度，一组患有重度抑郁症（MDD），另一组未患MDD。
本分析使用了一个便利样本的参与者（N = 231），这些参与者在一项旨在改善老年人（≥55岁）抗抑郁药依从性和抑郁结局的项目的随机对照试验中被新开具了抗抑郁药。在确定患有和未患有MDD的参与者比例（使用《精神疾病诊断与统计手册第四版》的结构化临床访谈）后，作者比较了两组在人口统计学、临床和社会心理特征方面的差异，包括12项简短健康调查问卷的身体和心理成分汇总得分（PCS和MCS）。使用逻辑回归来检验这些特征与在未患MDD情况下使用抗抑郁药之间的关联。
大多数（57%）参与者未患MDD。与患有MDD的组相比，该组年龄更大（69.4岁对64.7岁，p <.001），白人参与者比例更高（82%对56%，p <.001），并且报告的身体（PCS，43.4对39.9，p =.03）和情绪（MCS，40.2对30.5，p <.001）幸福感更好。在最终回归模型中，白人种族（调整后的优势比[AOR]=3.11，p =.03）和更好的情绪幸福感（AOR=1.16，p <.001）与在未患MDD情况下使用抗抑郁药相关。
未患MDD却被开具抗抑郁药的老年人与患有MDD的同龄人相比，并未报告类似的痛苦程度。鉴于初级保健中持续强调抑郁症筛查，考虑过度治疗的可能性很重要。
